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U.S. Department of Health and Human Services Department of Health and Human Services
Substance Abuse and Mental Health Services Administration

Substance Abuse & Mental Health Services Administration

Last Updated: 6/22/2012

SAMHSA’s Resource Center to Promote Acceptance,
Dignity and Social Inclusion Associated with
Mental Health (ADS Center)


1 de cada 4 (1 in 4)

Start Date

Brief Description
Developed in Andalusia, Spain, in September 2007, 1 de cada 4 (1 in 4 in English) is a campaign to increase public awareness of mental illnesses in order to reduce the stigma and discrimination experienced by people with mental illness.

Over the past few years, several international organizations have made stigma reduction a priority among their health initiatives. Recommendations for reducing the stigma surrounding mental illnesses have been developed by many organizations, including the Spanish government, the European Commission, the European Parliament, and the World Health Organization.

As reported in the 2001 World Health Report New Understanding, New Hope, "One in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill health and disability worldwide." The report states that nearly two-thirds of people with a known mental disorder never seek help from a health professional and that stigma, discrimination, and neglect prevent care and treatment from reaching people with mental illnesses.

Following the recommendations of the Spanish government and other international organizations, the Andalusian regional government's Department of Health decided to develop a campaign that would target the Spanish population.

The government developed the campaign with the following objectives in mind:

  • Raise awareness about mental illnesses.
  • Educate the public on the prevalence of mental illnesses.
  • Spread critical messages like 1) mental illnesses do not discriminate, 2) treatment is available and recovery is possible, and 3) stigma and discrimination can impede recovery.

1 de cada 4 advertising included public service announcements that were aired on television and radio. The campaign also used print media to support its message: newspaper ads, postcards for distribution in colleges and other venues, posters, and large-scale billboards. The print media has been distributed locally and used in Andalusian public health centers and on main streets.

The campaign also launched a comprehensive Web site,, as a complementary tool for the campaign. To date, it is the most in-depth Web site in Spain addressing stigma and discrimination. The Web site provides information and facts on stigma and discrimination and has a section where individuals can access personal stories from people who have a mental illness. The site also includes a 'stigma buster' section where individuals can aid the campaign in ensuring that the Spanish media portrays mental illnesses accurately, and also learn about and share strategies to reduce stigma and discrimination.

Feedback from the public has been very positive, particularly from mental health consumers and their families. Several individuals in the community have contacted the Campaign to inform them that the development and launch of the campaign was a necessary step in educating the public about mental illness. To date, the 1 de cada 4 Web site has received more than 7, 500 visits and over 29,000 hits. Additionally, several articles have been published addressing stigma and its effects in various Andalusian newspapers and a prominent Spanish newspaper, El Pais. The campaign is expected to continue through 2008.

For further information on the 1 de cada 4 campaign, contact the program administrators at or visit the campaign Web site at


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This Web site was developed under contract with the Office of Consumer Affairs in SAMHSA’s Center for Mental Health Services. The views, opinions, and content provided on this Web site do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. The resources listed in this Web site are not all-inclusive and inclusion on this Web site does not constitute an endorsement by SAMHSA or HHS.